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November 2015

Radiology Billing and also Coding: Professional and Technical Components By G. Man Verhovshek, MA, CPC Radiology Today Vol. 16 No. 11 P. 7

Most radiology solutions or procedures, although described by a single CPT code, consist of two distinct portions: a expert component and also a technological component.

The skilled component is detailed by the physician, and may encompass supervision, interpretation, and a created report. To case only the professional portion of a service, CPT postposition A ("Modifiers") instructs you to append full 26, skilled component, come the suitable CPT code. Modifier 26 is appropriate when the physician supervises and interprets a diagnostic test, even if the or she go not execute the test personally.

The technological component of a organization includes the provision of all equipment, supplies, personnel, and costs related to the power of the exam. To claim only the technical part of a service, append modifier TC, technological component, come the appropriate CPT code. Fees for the technical component room reimbursed come the facility or practice responsible because that these costs.

Hospitals typically are freed from appending full TC because it is assumed that the hospital is billing for the technical component part of any onsite service. Consult separation, personal, instance payers for certain coding instructions.

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The surest way to identify codes with different professional and technical materials for Medicare payers is come consult the national Physician dues Schedule relative Value File, easily accessible as a cost-free download native the Centers for Medicare & Medicaid solutions (CMS) website. The most recent paper as the September 2015 can be found at www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/PhysicianFeeSched/PFS-Relative-Value-Files.html. If the family member Value record lists separate line items for a code with modifiers 26 and also TC, the organization or procedure described by the code has both a technical and professional component.

For instance, the 2015 relative Value document lists three separate lines because that 74020, Radiologic examination, abdomen; complete, including decubitus and/or erect views. The an initial of this lines corresponds to the "global" service. The 2nd line details the technological component only, and the third line describes only the experienced component. Note that the separate loved one value units (RVUs) assigned because that the technical and also professional contents will same the total RVUs for the an international service (described below). The complete RVUs because that 74020 room 1.04, of i beg your pardon 0.66 RVUs are attributed come the technological component and 0.38 are attributed to the professional component.

Example 1 A chest X-ray is perform in a freestanding radiology clinic, and a doctor who is not employed through the facility interprets the films. The clinic will append comprehensive TC come the proper chest X-ray code (eg, 71010-TC, Radiologic examination, chest; solitary view, frontal-technical component) come account because that the cost of supplies and staff. The doctor who interprets the X-ray submits a case with comprehensive 26 appended (ie, 71010-26). The fee because that the organization will be split, with approximately 60% that payment allotted because that the technological component, and 40% because that the expert component.

A worldwide service has both the professional and technical components of a solitary service. When reporting a worldwide service, no modification are vital to obtain payment for both components of the service. If the provider that interprets the film additionally owns the equipment, a global service is submitted and also the professional and also technical materials are billed with each other (eg, the suitable CPT password is report without either modifier 26 or TC appended). The worldwide procedure code is it is registered at full fee.

Example 2 password 72040, Radiologic examination, spine, cervical; 2 or three views, includes both a technological component (the X-ray an equipment and important supplies and clinical employee to support its use) and a expert component (physician supervision, interpretation, and report). If spinal X-ray is performed at the physician"s office, either by a physician or a technician to work by the practice, report 72040 there is no a modifier due to the fact that the practice listed both contents of the service.

Note the radiologists who provide services because that Medicare patient in a hospital or facility setting cannot case the technical component the a procedure. Under the diagnosis-related group, the hospital/facility receives compensation because that the technical portion of Medicare inpatient services. Similarly, Medicare rules need that payment for nonphysician services provided to hospital patient (such together the services of a technician administering a diagnostic test) space made to the hospital.

Although the bulk of 7XXXX-series password do incorporate technical and professional components, if the fee schedule does not list different values for a code v modifiers 26 and TC (eg, 77071, manual application of stress and anxiety performed by doctor or other qualified health care professional for joint radiography, including contralateral joint if indicated), the modifiers room not suitable with that code under any circumstances.

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— G. Man Verhovshek, MA, CPC, is managing editor because that AAPC, the nation"s biggest medical credentialing organization.